Baby Has an Ear Infection

Feb. 18, 2002 -- No matter how conscientious parents are, babies are likely to come down with colds during their first year, and colds often lead to ear infections.

"The signs and symptoms can be very general, so they need to be looked at, especially in really young children less than 2 months of age," says Anthony Magit, MD, associate clinical professor at the University of California, San Diego, and the Children's Hospital and Health Center. Left untreated, ear infections can lead to more serious problems, including meningitis and hearing loss.

The typical ear infection -- called otitis media -- occurs when a cold or allergy causes swelling of the baby's eustachian tube, causing blockage that allows bacteria to grow in the middle ear.. Otitis media is particularly common in babies because their immune systems are immature and their eustachian tubes may not effectively drain fluid from the middle ear.

There are two types of middle ear infections. Acute otitis media often causes pain, fever, and a bulging red eardrum. Otitis media with effusion (OME) occurs when the middle ear doesn't drain properly and fluid is trapped behind the eardrum. A child may not experience pain with OME. Both types of infection sometimes clear up without treatment.

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The Latest in Ears

Because they're so run-of-the-mill, you may think you know all you need to know about ear infections. But treatment and prevention strategies have changed in the past year, so a refresher course may be in order. You should know that:

• There's now a vaccination for children under 2 to help ward off one of the most common bacterial causes of ear infections.
• Doctors are using antibiotics more conservatively in an effort to prevent drug resistance.
• There's a new laser surgery that might be worth considering in certain cases of recurring ear infections.

The newest weapon in the battle against otitis media is the pneumococcal vaccine. According to new American Academy of Pediatrics guidelines, all children under age 2 years should receive the vaccine, along with other recommended immunizations, at 2, 4, and 6 months and between 12 and 15 months.

"It's not 100 percent [effective], but it seems to result in about a 20% reduction in ear infections," says Albert Park, MD, assistant professor of pediatric otolaryngology at Loyola University Medical Center in Maywood, Ill. The vaccine is also recommended for children ages 2 to 5 who are at high risk for developing pneumococcal infections.

Antibiotic Balancing Act

If your child hasn't been vaccinated, or gets an infection anyway, your pediatrician will typically prescribe the antibiotic amoxicillin. The most acute symptoms should subside within 24 to 48 hours, but since the pain may continue for several days, acetaminophen and warm compresses may help relieve discomfort.

Make sure to administer the antibiotics for the prescribed time, or the infection might stick around, and your baby could need a new round of antibiotics, possibly a different kind, such as Ceclor, Augmentin, Ceftin, and Rocephin.

Concern about antibiotic overuse and the development of drug-resistant bacterial strains, has prompted doctors to look more carefully at ear infection symptoms before prescribing antibiotics. If a baby has acute otitis media, not the less-serious OME, the doctor is likely to prescribe a stronger dose of amoxicillin twice a day rather than the traditional three weaker doses, says Magit. Other, more powerful, antibiotics are reserved for harder-to-treat cases, particularly in children under 2.

Doctors are also now less likely to offer prophylactic therapy -- taking a low-dose antibiotic for several months to prevent recurring ear infections -- particularly during the winter cold season.

"People are shying away from using [antibiotics prophylactically] because of the concerns about resistance," says Dr. Magit. "It works, but you're giving a child a lot of antibiotics to prevent one ear infection."